. Operative surgery. ciently to admit of the disarticulation of the medio-tarsaljoint and of a horizontal section of the os calcis just below the sustentac-ulum tali. If the bone be divided from without inward, the posterior tibialartery is less likely to be injured. The wound is drained, the flaps areunited, and the stump is dressed antiseptically. After-treatment.—The wounded part should be kept raised, well venti-lated, and lying on the side. It is better that drainage agents be limited tothe openings than that they should extend through from side to side. Heelflaps may be punctured longitu
. Operative surgery. ciently to admit of the disarticulation of the medio-tarsaljoint and of a horizontal section of the os calcis just below the sustentac-ulum tali. If the bone be divided from without inward, the posterior tibialartery is less likely to be injured. The wound is drained, the flaps areunited, and the stump is dressed antiseptically. After-treatment.—The wounded part should be kept raised, well venti-lated, and lying on the side. It is better that drainage agents be limited tothe openings than that they should extend through from side to side. Heelflaps may be punctured longitudinally for drainage. The Results.—An analysis of 880 cases of tarsal amputations, includ-ing the methods of Lisfranc, Chopart, and the modifications, shows that of638 cases done before asepsis, per cent died, and of 253 operationsperformed under asepsis, per cent died. Amputation at the Ankle Joint—Removal of the Entire Foot (SymesMethod).—Symes amputation may be considered one of the most practical. Fig. 587.—Symes method, outer incision. Fig. 588.—Inner incision. of the operations on the foot and ankle. It is followed not only by a low rateof mortality, but also by a most serviceable stump, either with or without anartificial appliance. The patient is placed upon a table with the leg over-hanging it, the thigh raised by an assistant, who at the same time flexes thecondemned foot upon the leg by seizing and pulling upward on its anteriorportion. The outlines of the respective flaps should now be carefully drawnbefore the incisions are commenced. The line indicating the proper courseof the plantar incision begins at the apex of the external malleolus, andwith a slight backward inclination passes around the foot (Fig. 587) to apoint opposite to its beginning, which is about a fingers breadth below theapex of the internal malleolus (Fig. 588). The second or dorsal line is drawn directly across the instep, and con-nects the extremities of the plantar incision
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Keywords: ., bookauthorbryantjosephdjosephde, bookcentury1900, bookdecade1900
